Request for Pre-Qualification - City Town Info
Request for Pre-Qualification
This is not an application for a mortgage loan. The information provided is to be used to determine
the likelihood that the named borrowers will be able to obtain a mortgage loan. All information is
subject to verification at the time of application for a mortgage loan.
General Information
Purchasing (check one)
Single Family Condo Multi-Family
Amount for Down Payment
$
First time home buyer? Yes
No
Borrower Information
Borrower
Co-Borrower
Name:
Name:
Social Security Number:
Social Security Number:
Date of Birth:
Date of Birth:
Present Address (street, city, state, ZIP)
Present Address (street, city, state, ZIP)
Home Phone
( )
Home Phone
( )
Work Phone
( )
Work Phone
( )
E-Mail
E-Mail
Name of Employer
Name of Employer
Title/Position
Title/Position
Years at Employer
Years at Employer
Income Information
Do you have income documentation? Yes No
Base Salary
$
Base Salary
$
Overtime
Overtime
Bonuses
Bonuses
Commissions
Commissions
Other
Other
Total
$
Total
$
Asset/Liability Information
Assets
Liabilities
Amount
Monthly Payment
Checking/Savings
$
Home Loan
$
Investment
Credit Card Debt
Retirement
Auto Loan
Other (describe)
Other Loans (student
loans, equity lines etc.)
Total
$
Total
$
I hereby authorize Sample Mortgage Corporation to order a consumer credit report. The information
Sample Mortgage Corporation obtains is only to be used for mortgage pre-qualification purposes and
potential subsequent processing of my application for a mortgage loan.
Borrower Signature
Date
Co-Borrower Signature
Date
................
................
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